RDNS takes to the road with mobile devices

Written by Kate McDonald on 24 June 2014.

An edited version of this story first appeared in the May 2014 issue of Pulse+IT Magazine.

RDNS has recently undertaken a refresh of its mobile computing device deployment, rolling out a new range of lightweight devices with improved battery life and several layers of connectivity. The organisation is also exploring the use of telehealth through its BEIP project as well as interfaces with GP software, and is also keenly watching developments with the implementation of the Aged Care Gateway and the PCEHR.

RDNS has used mobile devices for its nurses for well over a decade and was one of the pioneers of mobile computing at the point of care in Australia. This is not a surprise, considering the highly mobile working conditions of its nurses, who visit a range of clients, many of them frail and elderly, in their homes.

In what is perhaps the fifth refresh of its mobile computing fleet, this year RDNS has rolled out new Lenovo Helix convertible ultrabooks, which allow nurses to use the devices as a tablet for quick access to information but which also come with a keyboard for easier data entry.

Nurses have full access to a range of software and applications used by RDNS, including its Camillus electronic client record, designed by Ascribe, and a system called Gemino, which acts as a store-and-forward back-up application to capture important data and hold it on the device even if connectivity is lost.

Connectivity is essential for RDNS nurses, many of whom travel considerable distances to see clients in their homes. The organisation is also involved in telehealth trials, including one that allows nurses staffing its Customer Service Centre to teleconference with clients every morning to observe them taking their medications.

The device rollout and the telehealth trials are all part of the organisation's strategy to use technology to better equip nurses with what they need in their daily work. RDNS project manager Owen Smith describes the strategy as “crafting a service model that is closely aligned to a day in the life of a nurse”, and when the organisation issued a request for tender to refresh the mobile device fleet, it provided a use case scenario illustrating a day in the life of a typical RDNS nurse.

“When vendors come to talk to RDNS, invariably they are amazed at how mobile RDNS is,” Mr Smith says. “A lot of sales organisations think they have road warriors but they pale when they see that the nurses have 30 minutes of office time in an eight-hour day and the challenges are broad ranging. It's not people going from city office to city office with 4G at their fingertips. It is quite the opposite – it is going into the most difficult environments.”

Full-time nurses and those who work for more than 20 hours a week are given the device to take home with them, while part-timers often share a device. There is also an agreement with the vendor that a broken device will be replaced within a day, and there are spare devices at each base in case of equipment failure.

“By creating that very close alignment, the end goal was minimum user downtime through device failure,” Mr Smith says. “We can say that an RDNS nurse always has a device instantly. It is very responsive.”

For RDNS, the most important elements in choosing a device are connectivity, light weight and robustness, he says. “We are trying to keep the weight down, battery life up and connectivity as broad ranging and as extensible as possible. We are quite sharply focused on getting right down to specific protocols that the modem should have, especially for outlying areas were the signal strength is very poor. That was one key – we wanted to be able to have live online acquisition of data in as many homes as possible.”

RDNS has over-specified the devices to ensure reliability. They all have a minimum of an Intel i5 processor with some high-end application devices having an i7, and they all have an onboard 3G modem with a data plan so there is connectivity anywhere that Telstra has a network, which these days is about 90 per cent of the country. However, RDNS also wanted to ensure the devices connect in areas with patchy coverage, so it has asked for a little extra.

“That is the sort of spec that we wanted,” Mr Smith says. “4G is not as important to us, as while it has good speed it has poor coverage. We are more concerned with what is called a '3.5G' technology, HSDPA-DC. That is a dual carrier technology and allows the device to connect to two adjacent cell towers at the same time. That increases your chances of getting a signal in marginal areas.”

The detachable dock in the device has a secondary battery, which allows users to keep the dock on charge while the tablet is being used. As nurses need to be able to charge the device in their vehicle, the rapid charging capability of the device has been a great advantage, RDNS Victorian general manager, Fiona Hearn, says.

Nurses also have the ability to use the system locally and turn on the signal only when they need to in order to save battery life. They are provided with access to Camillus, and there is also a separate software product for rostering staff called RosterOn that interfaces into the client record.

Ms Hearn says nurses staffing the Customer Service Centre are also able to receive calls from nurses on site, see the live record and make changes, all in near real time. With the Gemino application, if there is a momentary loss of connectivity, all of the data is kept locally and is sent when a connection is re-established.

“In addition, the staff have the full compliment of Microsoft-based products, including Outlook, the internet and the intranet,” Ms Hearn says. “RDNS has a very well-developed intranet with clinical pages, information about what we doing on wounds for instance.

“All of our policies and procedures are electronic which means that as we update our policy, I don't have to send paper out everywhere and worry about version control, because it is only available electronically. And essential for clinicians, we have the full fleet of drug information like MIMS.”

Mobile telehealth

The next step is to investigate providing telehealth capability through the devices, which is now underway. In the last few years, RDNS has done a lot of project work looking at the opportunities presented by telehealth, including the ongoing Broadband Enabled Innovation Project (BEIP), which is providing teleconferencing into people's homes to help with medication compliance.

BEIP, which won the Outstanding ICT Innovation award in the Asia Pacific Eldercare Innovation Awards 2013 in Singapore last year, initially used an Intel Home Care device to facilitate the teleconferencing. The trial involves a daily video conference through the Intel device with clients in their home, in which they are prompted to take their medications. A nurse at the RDNS call centre in Melbourne observes the client as they take their meds, and checks the medications pack to ensure it is correct.

Intel has since removed that device from the Australian market, so RDNS is now using Samsung devices and iPads in clients' homes as the organisation wants to develop a system that can be used on any device, Ms Hearn says. That includes the Lenovo devices the nurses are using themselves.

“In the past couple of years we have done quite a lot of project work looking at the opportunities presented through telehealth,” she says. “We see that as a central plank of how we go forward because we've got a rapidly ageing population, there are significant predicted workforce issues in the nursing workforce, the taxpayer base is decreasing over time, and we really have to come up with models that make best use of the expertise that is available to us.

“Clearly telehealth provides a great opportunity. We are supporting quite a number of clients now with monitoring of vital signs, and that has had a two-fold effect. One is that we are able to take action if required, but secondly they become much more involved in their own care. You get improvements from that, from their engagement and self-knowledge, which really increases by using these mobile devices.”

RDNS first ventured into telehealth some years ago and ran a more workforce-focused project involving both GPs and nurses, looking at how clients could be monitored well enough that visits could be reduced. Ms Hearn says that project assisted RDNS in understanding the roles and structures of telehealth provision, which has transferred over to the BEIP trial.

“Now we are working in relation to broadband and how you can best capitalise on that availability. Once again we are looking at not only how we benefit our own business but we are thinking about how we work in collaboration with doctors and clients. The project is looking very interesting.”

Integration with GPs

RDNS is also investigating how to share information with GP information systems, including Precedence Health Care's cdmNET, which has been designed to facilitate GP management plans

“We are also looking at the PCEHR, although we are not playing in that field yet. Not that many people are, but we are certainly interested in it. We also work very closely with palliative care organisations in Victoria and some of those have enabled access for us so that our staff can actually view that in our Customer Service Centre. They are able to see into that record as well as our record.

“And we are keenly following the implementation of the Aged Care Gateway, which will have a central client record that will assist service providers.”

RDNS is also using simple, free technology like Google Hangouts to improve communication within the organisation and also to make better use of its expert clinicians as part of what Mr Smith calls an enterprise social network.

“It's sort of like internal crowdsourcing, where somebody who needs assistance from a colleague can very quickly locate that colleague just through a search within the directory or a keyword in a person's profile, such as diabetes or wound specialist,” he says. “You'd immediately see a list of the colleagues that would be appropriate to provide assistance in that scenario, and then bring them to that point of care very quickly over a Hangout.”

This can be used by nurses when they are on site looking at a wound, Ms Hearn says. “With the nurse using her mobile computer, you can actually show the wound. It's not really the same as the high quality you'd get from Cisco or Polycom, and we are working through these issues now, but it certainly means that we can have a much greater collaboration at the client end, at the point of care.

“That social media context of creating groups around wounds or diabetes is an opportunity to bring together a lot of the client's clinicians and that's the path we moving along at the moment.”

While RDNS has used high-end video conferencing suites, Mr Smith says he is investigating using WebRTC for mobile telehealth, as it can be used with the main internet browsers.

“There have been a number of explorations in that area,” he says. “Some of the problems with the proprietary systems is that you can get a gold-plated system that does all things, but they can be so expensive that they can't be deployed under a government-funded model. With a user pays system it would work, but that would leave out a large amount of our target clients.

“We have explored WebRTC, which is the emerging technology and a buzzword in the industry, and RDNS has already completed and operationalised delivery of tele-counselling services using WebRTC. The beauty of it is that anyone who has the appropriate browser, which is pretty much Internet Explorer 8 onwards, you have a little plug-in and that immediately opens it to the vast amount of Australians simply with any device and a browser.

“We're very closely paying attention to which technology fits the right scenario, and we have a requirements-based approach to the best available technology – that's one of our mantras. The best available that is going to fit the purpose, that's what we do.

“RDNS's tagline and one of our missions is 'by your side', so the naturalist extension of that in this modern world is 'by your side, anywhere, any place, any time'.”